Telomerase polypeptide vaccine for treating cancer

ABSTRACT

A polypeptide comprising the sequence of SEQ. ID NO. 2, 3, 4, 7 or 8. The polypeptide may have the sequence of an immunogenic fragment thereof comprising at least eight amino acids, wherein the immunogenic fragment is not one of SEQ. ID NOS. 6 or 11 to 16. The polypeptide may have a sequence having at least 80% sequence identity to the aforementioned polypeptide or immunogenic fragment. The polypeptide is less than 100 amino acids in length and does not comprise the sequence of any of SEQ. ID NOS. 10, 46, 56, 57 or 59 to 62 and does not consist of the sequence of SEQ ID NO. 58. The polypeptide is useful in the treatment or prophylaxis of cancer.

RELATED APPLICATIONS

This application is a Division of U.S. application Ser. No. 13/578,969,which is a §371 National Phase Application of International ApplicationNo. PCT/EP2011/000980, filed on Feb. 15, 2011, which claims priority toEuropean Application No. 10250265.5, filed on Feb. 16, 2010, all ofwhich are incorporated herein by reference in their entirety,

INCORPORATION BY REFERENCE OF MATERIAL IN ASCII TEXT FILE

This application incorporates by reference the Sequence Listingcontained in the following ASCII text file:

File name: 0332-0001US2_PN791356USA_Sequence_Listing.TXT; created Apr.12, 2017, 11 KB in size.

FIELD OF THE INVENTION

The present invention relates to a polypeptide and to a nucleic acidmolecule consisting of a nucleotide sequence encoding the polypeptides.The invention also relates to a cocktail of polypeptides and to acocktail of nucleic acid molecules. The invention further relates to apharmaceutical composition comprising such a polypeptide, nucleic acidmolecule or cocktail thereof. In addition, the present invention relatesto methods of treatment or prophylaxis of cancer in a patient comprisingadministering the polypeptide, nucleic acid molecule or cocktail to thepatient.

BACKGROUND OF THE INVENTION

Cancer is a disease characterised by new and abnormal growth of cellswithin an individual. Cancer develops through a multi-step processinvolving several mutational events that allow cancer cells to develop,that is to say cells which display the properties of invasion andmetastasis. Generally speaking, there are two classes of genes in whichmutation can occur and give rise to cancer: oncogenes and tumoursuppressor genes. The activation of oncogenes gives rise to newproperties of the cell such as hyperactive growth and division,protection against programmed cell death, loss of respect for normaltissue boundaries and the ability to become established in diversetissue environments. Tumour suppressor genes can be inactivated whichpermits the loss of normal functions in the cell such as accurate DNAreplication, control over the cell cycle, orientation, and adhesionwithin tissues and interaction with protective cells of the immunesystem.

Numerous approaches have been proposed for the treatment and prophylaxisof cancer. One approach is the use of antigenic peptides which comprisefragments of tumour specific antigens. Such antigenic peptides, whenadministered to an individual, elicit an MHC class I or class IIrestricted T-cell response against cells expressing the tumour specificantigens.

It is to be appreciated that in order for such a T-cell response tooccur, the antigenic polypeptide must be presented on an MHC molecule.There is a wide range of variability in MHC molecules in humanpopulations. In particular, different individuals have different HLAalleles which have varying binding affinity for polypeptides, dependingon the amino acid sequence of the polypeptides. Thus an individual whohas one particular HLA allele may have MHC molecules that will bind apolypeptide of a particular sequence whereas other individuals lackingthe HLA allele will have MHC molecules unable to bind and present thepolypeptide (or, at least, their MHC molecules will have a very lowaffinity for the polypeptide and so present it at a relatively lowlevel).

It has also been proposed to provide a vaccine comprising a nucleic acidmolecule that encodes such an antigenic peptide. Such a vaccine operatesby way of a similar principle except that after administration of thevaccine to an individual in need of treatment, the nucleic acid moleculeis transcribed (if it is DNA molecule) and translated in order tosynthesise the peptide which is then bound and presented by an MHCmolecule as described above.

Telomerase is an enzyme that has the function of replicating the 3′ endof the telomere regions of linear DNA strands in eukaryotic cells asthese regions cannot be extended by the enzyme DNA polymerase in thenormal way. The telomerase enzyme comprises a telomerase reversetranscriptase subunit (“TERT” or “hTERT” for humans) and telomerase RNA.By using the telomerase RNA as a template, the telomerase reversetranscriptase subunit adds a repeating sequence to the 3′ end ofchromosomes in eukaryotic cells in order to extend the 3′ end of the DNAstrand.

It has been observed that the telomerase enzyme is activated in the vastmajority of all human tumours. It is believed that this occurs because,without the expression of the telomerase enzyme, the telomeres of cellsare gradually lost, and the integrity of the chromosomes decline witheach round of cell division of a cell which ultimately results inapoptosis of the cells. Thus, expression of the telomerase enzyme isgenerally necessary for a cancer cell to develop because without suchexpression, programmed cell death will usually occur by default. In viewof the role of telomerase activation in cancer, telomerase has beenregarded as a tumour specific antigen and thus as a potential target forcancer therapy.

WO03/038047 discloses a peptide designated as T672 which is reported toelicit a proliferative T-cell response from cells of healthy donors.Various other peptides of hTERT are also disclosed but were not subjectto any experimental testing.

WO00/02581 discloses polypeptides of telomerase which elicit an MHCclass I and/or class II restricted T-cell response. One of thepolypeptides disclosed (having the amino acid sequence EARPALLTSRLRFIPK,which is also known as GV1001) is undergoing a phase III clinical trial(Telo Vac) in the UK in pancreatic cancer patients as a vaccinetreatment.

WO02/094312 discloses certain polypeptides derived from hTERT. Liu J Pet al (2009 Telomerase in cancer immunotherapy Biochim Biophys Acta.September 12) reviewed 26 hTERT peptides that had been shown to induceefficient immune responses to hTERT positive tumour cells.

Dendritic cells transfected with hTERT mRNA have also previously beenemployed to treat metastatic prostate cancer patients (Su et al, 2005,Telomerase mRNA-transfected dendritic cells stimulate antigen-specificCD8+ and CD4+ T cell responses in patients with metastatic prostatecancer. J Immunol. 174(6):3798-807). Su et al demonstrated successfulgeneration of hTERT-specific T cell responses measured as IFNγ secretingCD8+ T cells and CTL-mediated killing of hTERT targets. Four patientsalso experienced partial clinical responses. However, no hTERT epitopeswere characterized in these studies.

There is always a need for further antigenic polypeptides (and nucleicacid molecules which encode such polypeptides) for the treatment ofcancer, such as polypeptides which can elicit a more effective immuneresponse in individuals and/or polypeptides which are presented by HLAalleles present in a greater proportion of the population.

The present seeks to alleviate one or more of the above problems.

SUMMARY OF THE INVENTION

According to a first aspect of the present invention, there is provideda polypeptide comprising a sequence selected from:

-   -   i) SEQ. ID NOS. 2, 3, 4, 7, 8 or 9;    -   ii) the sequence of an immunogenic fragment of i) comprising at        least eight amino acids, wherein the immunogenic fragment is not        one of SEQ. ID NOS. 6 or 11 to 16; or    -   iii) a sequence having at least 80% sequence identity to i) or        ii), wherein the polypeptide is less than 100 amino acids in        length and wherein the polypeptide does not comprise the        sequence of either of SEQ. ID NOS. 10 or 56.

It is preferred that the polypeptide does not comprise the sequence ofany of SEQ. ID NOS. 46, 57 or 59 to 62 and does not consist of thesequence of SEQ ID NO. 58.

The polypeptide is isolated which is to say that it does not form partof the protein (hTERT) in which it naturally occurs.

The polypeptide is capable of eliciting a T-cell response in a healthypatient with an HLA allele appropriate for displaying the polypeptide.

Conveniently, the sequence of the polypeptide according to the firstaspect of the present invention is defined as a sequence selected from:

-   -   i) SEQ. ID NO. 1;    -   ii) the sequence of an immunogenic fragment of i) comprising at        least eight amino acids, wherein the immunogenic fragment is not        one of SEQ. ID NOS. 6, 11 to 16 or 56; and    -   iii) a sequence having at least 80% sequence identity to i) or        ii),        wherein the polypeptide is less than 100 amino acids in length.        That is to say, the polypeptide may comprise the sequence of        SEQ. ID NO. 1 which incorporates the sequences of SEQ. ID NOS. 2        and 3 and need not be in addition to the sequences of SEQ. ID        NOS. 2 and 3.

It is preferred that the polypeptide does not consist of the sequence ofSEQ ID NO. 58.

Preferably, the immunogenic fragment has the sequence of any one of SEQ.ID NOS. 17 to 40.

Advantageously, the polypeptide is less than or equal to 80, 50, 30, 20or 11 amino acids in length.

According to a second aspect of the present invention, there is provideda nucleic acid molecule consisting of a nucleotide sequence encoding apolypeptide according to the invention.

The nucleic acid molecule is isolated which is to say that it does notform part of the gene (the telomerase gene) in which it naturallyoccurs.

According to a third aspect of the present invention, there is provideda cocktail of polypeptides comprising at least two differentpolypeptides comprising sequences selected from the group consisting of:

-   -   i) SEQ. ID NOS. 2 to 7;    -   ii) the sequence of an immunogenic fragment of i) comprising at        least eight amino acids; and    -   iii) a sequence having at least 80% sequence identity to i) or        ii),        wherein each polypeptide is less than 100 amino acids in length.        It is preferred that said at least two polypeptides are        different in the sense that the sequence defined in i) is        different for each polypeptide.

Conveniently, the sequence of at least one of the polypeptides isdefined as comprising a sequence selected from the group consisting of:

-   -   i) SEQ. ID NOS. 1, 7, 8, 9 or 10;    -   ii) the sequence of an immunogenic fragment of i) comprising at        least eight amino acids; and    -   iii) a sequence having at least 80% sequence identity to i) or        ii),        wherein the polypeptides are less than 100 amino acids in        length. For example, one of the polypeptides may comprise the        sequence of SEQ. ID NO. 1 which incorporates SEQ. ID NOS, 2 and        3 and need not be in addition to the sequence of SEQ. ID NOS. 2        and 3.

Advantageously, the at least two different polypeptides comprise acocktail of polypeptides selected from the group consisting of:

-   -   i) a cocktail of: a polypeptide comprising the sequence of SEQ.        ID NO. 1 or a sequence having at least 80% sequence identity        thereto or an immunogenic fragment thereof comprising at least        eight amino acids; a polypeptide comprising the sequence of SEQ.        ID NO. 7 or a sequence having at least 80% sequence identity        thereto or an immunogenic fragment thereof comprising at least        eight amino acids; and a polypeptide comprising the sequence of        SEQ. ID NO. 9 or a sequence having at least 80% sequence        identity thereto or an immunogenic fragment thereof comprising        at least eight amino acids;    -   ii) a cocktail of: a polypeptide comprising the sequence of SEQ.        ID NO. 1 or a sequence having at least 80% sequence identity        thereto or an immunogenic fragment thereof comprising at least        eight amino acids; a polypeptide comprising the sequence of SEQ.        ID NO. 8 or a sequence having at least 80% sequence identity        thereto or an immunogenic fragment thereof comprising at least        eight amino acids; and a polypeptide comprising the sequence of        SEQ. ID NO. 9 or a sequence having at least 80% sequence        identity thereto or an immunogenic fragment thereof comprising        at least eight amino acids; and    -   iii) a cocktail of: a polypeptide comprising the sequence of        SEQ. ID NO. 1 or a sequence having at least 80% sequence        identity thereto or an immunogenic fragment thereof comprising        at least eight amino acids; a polypeptide comprising the        sequence of SEQ. ID NO. 8 or a sequence having at least 80%        sequence identity thereto or an immunogenic fragment thereof        comprising at least eight amino acids; and a polypeptide        comprising the sequence of SEQ. ID NO. 10 or a sequence having        at least 80% sequence identity thereto or an immunogenic        fragment thereof comprising at least eight amino acids,    -   wherein each polypeptide is less than 100 amino acids in length.

Preferably, the or each immunogenic fragment has a sequence of any oneof SEQ. ID NOS. 17 to 40.

According to a fourth aspect of the present invention, there is provideda cocktail of nucleic acid molecules comprising at least two differentnucleic acid molecules consisting of a nucleic acid sequence encoding apolypeptide comprising a sequence selected from a group consisting of:

-   -   i) SEQ. ID NOS. 2 to 7;    -   ii) the sequence of an immunogenic fragment of i) comprising at        least eight amino acids; and    -   iii) a sequence having at least 80% sequence identity to i) or        ii);        wherein the polypeptide is less than 100 amino acids in length.        It is preferred that said at least two nucleic acid molecules        are different in the sense that the sequence defined in i) is        different for each nucleic acid molecule.

Advantageously, at least one nucleic acid molecule is defined asconsisting of a nucleic acid sequence encoding a polypeptide comprisinga sequence selected from a group consisting of:

-   -   i) SEQ. ID NOS. 1, 7, 8, 9 or 10;    -   ii) the sequence of an immunogenic fragment of i) comprising at        least eight amino acids; and    -   iii) a sequence having at least 80% sequence identity to i) or        ii),        wherein the polypeptides are less than 100 amino acids in        length. For example, a nucleic acid molecule may consist of the        nucleic acid sequence encoding a polypeptide comprising SEQ. ID        NO. 1 which incorporates SEQ. ID NOS. 2 and 3 and the        polypeptide need not additionally comprise the sequence of SEQ.        ID NOS. 2 and 3.

Preferably, the at least two different nucleic acid molecules comprise acocktail of nucleic acid molecules selected from the group consistingof:

-   -   i) a cocktail of: a nucleic acid molecule consisting of a        nucleic acid sequence encoding a polypeptide comprising a        primary sequence of SEQ. ID NO. 1 or a secondary sequence having        at least 80% sequence identity to the primary sequence or an        immunogenic fragment of the primary sequence or the secondary        sequence comprising at least eight amino acids; a nucleic acid        molecule consisting of a nucleic acid sequence encoding a        polypeptide comprising a primary sequence of SEQ. ID NO. 7 or a        secondary sequence having at least 80% sequence identity to the        primary sequence or an immunogenic fragment of the primary        sequence or the secondary sequence comprising at least eight        amino acids; and a nucleic acid molecule consisting of a nucleic        acid sequence encoding a polypeptide comprising a primary        sequence of SEQ. ID NO. 9 or a secondary sequence having at        least 80% sequence identity to the primary sequence or an        immunogenic fragment of the primary sequence or the secondary        sequence comprising at least eight amino acids;    -   ii) a cocktail of: a nucleic acid molecule consisting of a        nucleic acid sequence encoding a polypeptide comprising a        primary sequence of SEQ. ID NO. 1 or a secondary sequence having        at least 80% sequence identity to the primary sequence or an        immunogenic fragment of the primary sequence or the secondary        sequence comprising at least eight amino acids; a nucleic acid        molecule consisting of a nucleic acid sequence encoding a        polypeptide comprising a primary sequence of SEQ. ID NO. 8 or a        secondary sequence having at least 80% sequence identity to the        primary sequence or an immunogenic fragment of the primary        sequence or the secondary sequence comprising at least eight        amino acids; and a nucleic acid molecule consisting of a nucleic        acid sequence encoding a polypeptide comprising a primary        sequence of SEQ. ID NO. 9 or a secondary sequence having at        least 80% sequence identity to the primary sequence or an        immunogenic fragment of the primary sequence or the secondary        sequence comprising at least eight amino acids; and    -   iii) a cocktail of: a nucleic acid molecule consisting of a        nucleic acid sequence encoding a polypeptide comprising a        primary sequence of SEQ. ID NO. 1 or a secondary sequence having        at least 80% sequence identity to the primary sequence or an        immunogenic fragment of the primary sequence or the secondary        sequence comprising at least eight amino acids; a nucleic acid        molecule consisting of a nucleic acid sequence encoding a        polypeptide comprising a primary sequence of SEQ. ID NO. 8 or a        secondary sequence having at least 80% sequence identity to the        primary sequence or an immunogenic fragment of the primary        sequence or the secondary sequence comprising at least eight        amino acids; and a nucleic acid molecule consisting of a nucleic        acid sequence encoding a polypeptide comprising a primary        sequence of SEQ. ID NO. 10 or a secondary sequence having at        least 80% sequence identity to the primary sequence or an        immunogenic fragment of the primary sequence or the secondary        sequence comprising at least eight amino acids,    -   wherein each polypeptide is less than 100 amino acids in length.

Conveniently, the or each immunogenic fragment has the sequence of anyone of SEQ. ID NOS, 17 to 40.

According to a fifth aspect of the present invention, there is provideda pharmaceutical composition comprising a polypeptide of the invention,a nucleic acid molecule of the invention, a cocktail of polypeptides ofthe invention or a cocktail of nucleic acid molecules of the inventionand a pharmaceutically acceptable adjuvant, diluent or excipient andoptionally another therapeutic ingredient.

Preferably, the polypeptide, nucleic acid molecule, cocktail ofpolypeptides or cocktail of nucleic acid molecules is present in anamount of between 50 and 200 μg.

According to a sixth aspect of the present invention, there is provideda method of treatment or prophylaxis of cancer in a patient comprisingadministering the polypeptide of the invention, the nucleic acidmolecule of the invention, the cocktail of polypeptides of theinvention, the cocktail of nucleic acid molecules of the invention orthe pharmaceutical composition of the invention to the patient.

According to a seventh aspect of the present invention, there isprovided a polypeptide of the invention, a nucleic acid molecule of theinvention, a cocktail of polypeptides of the invention, a cocktail ofnucleic acid molecules of the invention or a pharmaceutical compositionof the invention for use in medicine.

Advantageously, the polypeptide, nucleic acid molecule, cocktail ofpolypeptides, cocktail of nucleic acid molecules or pharmaceuticalcomposition is for use in the treatment or prophylaxis of cancer.

According to an eighth aspect of the present invention, there isprovided the use of a polypeptide of the invention, a nucleic acidmolecule of the invention, a cocktail of polypeptides of the invention,a cocktail of nucleic acid molecules of the invention or apharmaceutical composition of the invention for the manufacture of amedicament for the treatment or prophylaxis of cancer.

The terms “polypeptide”, “peptide” and “protein” are usedinterchangeably herein to refer to a polymer of amino acid residues. Theterms apply to amino acid polymers in which one or more amino acidresidues is a modified residue, or a non-naturally occurring residue,such as an artificial chemical mimetic of a corresponding naturallyoccurring amino acid, as well as to naturally occurring amino acidpolymers.

The term “amino acid” as used herein refers to naturally occurring andsynthetic amino acids, as well as amino acid analogues and amino acidmimetics that have a function that is similar to the naturally occurringamino acids. Naturally occurring amino acids are those encoded by thegenetic code, as well as those modified after translation in cells (e.g.hydroxyproline, gamma-carboxyglutamate, and O-phosphoserine). The phrase“amino acid analogue” refers to compounds that have the same basicchemical structure (an alpha carbon bound to a hydrogen, a carboxygroup, an amino group, and an R group) as a naturally occurring aminoacid but have a modified R group or modified backbones (e.g. homoserine,norleucine, methionine sulfoxide, methionine methyl sulphonium). Thephrase “amino acid mimetic” refers to chemical compounds that havedifferent structures from but similar functions to naturally occurringamino acids,

The term “fragment” as used herein in relation to a polypeptide means aconsecutive series of amino acids that form part of the polypeptide. An“immunogenic fragment” of a polypeptide is a fragment as previouslydefined which is capable of eliciting an immune response, such as aT-cell response, when administered to an individual.

The terms “gene”, “polynucleotides”, and “nucleic acid molecules” areused interchangeably herein to refer to a polymer of multiplenucleotides. The nucleic acid molecules may comprise naturally occurringnucleic acids or may comprise artificial nucleic acids such as peptidenucleic acids, morpholin and locked nucleic acid as well as glycolnucleic acid and threose nucleic acid.

The term “nucleotide” as used herein refers to naturally occurringnucleotides and synthetic nucleotide analogues that are recognised bycellular enzymes.

The term “treatment” as used herein refers to any partial or completetreatment and includes: inhibiting the disease or symptom, i.e.arresting its development; and relieving the disease or symptom, i.e.causing regression of the disease or symptom.

In this specification, the percentage “identity” between two sequencesis determined using the BLASTP™ (“Basic Local Alignment Search Tool,” analgorithm that finds regions of similarity between biological sequences)algorithm version 2.2.2 (Altschul, Stephen F., Thomas L. Madden,Alejandro A. Schïffer, Jinghui Zhang, Zheng Zhang, Webb Miller, andDavid J. Lipman (1997), “Gapped BLAST@ and PSI-BLAST™: a new generationof protein database search programs”, Nucleic Acids Res. 25:3389-3402)using default parameters. In particular, the BLAST algorithm can beaccessed on the internet using the URLhttp://www.ncbi.nlm.nih.gov/blast/.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 is a bar graph summarising hTERT T-cell responses detected inpancreas cancer patient vaccinated with DC transfected with hTERT mRNA.In samples from various time points throughout a vaccination schedule,T-cell responses against 24 overlapping hTERT 15-mer peptides weredetected. Proliferation in response to peptide-loaded PBMC was measuredby ³H-thymidine incorporation. A stimulation index of >2 is consideredan immune response.

FIG. 2 is a series of diagrams showing the detection of hTERT-specificHLA-A2 restricted CD8+ T cells by flow cytometry in vaccinated cancerpatients. PBMC were stained directly after isolation without priorantigen stimulation. Pentamer staining is shown in cells gated on CD8+CD3+ cells. Background staining shown in plot with irrelevant pentamer(HIV-peptide), hTERT pentamer plots show staining for two novel hTERTpeptides in a pancreas cancer patient (A) (the peptide referred to as720GLL corresponds to SEQ. ID NO. 3; the peptide referred to as 728RLTcorresponds to SEQ. ID NO. 6) and for a third hTERT peptide detected ina lung cancer patient (B) (the peptide referred to as 613RPA correspondsto SEQ. ID NO. 5), the latter at two different time points, five yearsapart. 45 000 CD8+ T cells were analysed.

FIG. 3 is a graph showing T-cell proliferation in response to GV1001peptide (SEQ. ID NO. 10), 663-677 (15-mer) (SEQ. ID NO. 2) and 660-689(30-mer) (SEQ. ID NO. 1). Stimulation index is a measure of how manyfold above background the peptide-specific proliferation is.

FIG. 4 is a graph showing the results of CD4+ T-cell clonesdemonstrating peptide-specific proliferation in response to decreasingpeptide concentrations. A value above 2 is considered as a positiveresponse.

FIG. 5 is a graph showing the results of detection of CD8+ T lymphocytesspecific for the 9- or 10-mer peptides of SEQ. ID NOS, 3, 4 and 6directly in peripheral blood mononuclear cells (PBMC) from patient bloodsamples. The 615-624 peptide (SEQ. ID NO. 4) was not tested in the twolast patients. The patients are HLA-A2+. Background staining withirrelevant pentamer was <0.05%.

FIG. 6 is a graph showing the results of detection of CD8+ T lymphocytesspecific for the 9-mer peptide 613-621 (SEQ. ID NO. 5) in a lung cancerpatient who has been in complete remission for several years afterGV1001 vaccination (SEQ. ID NO. 10). The patient is HLA-B7+. The patienthas subsequently been vaccinated every 6 months and a stable CD8+ T cellpopulation specific for hTERT peptide 613-621 can still be detected sixyears after the patient experienced complete remission. A second minorCTL population specific for another CTL epitope, 672-681 (SEQ ID. NO,25), was detected at some time points.

FIG. 7 is a graph showing T-cell response against hTERT overlappingpeptide library in a melanoma patient following vaccination with GV1001(SEQ. ID NO. 10).

FIG. 8 is a graph showing T-cell response against hTERT overlappingpeptide library in a lung cancer patient following vaccination withGV1001 (SEQ. ID NO. 10).

FIG. 9 is a graph showing T-cell response against hTERT overlappingpeptide library in a colon cancer patient following vaccination withGV1001 (SEQ. ID NO. 10).

FIG. 10 is a graph showing T-cell response against hTERT overlappingpeptide library in a second melanoma patient following vaccination withGV1001 (SEQ. ID NO. 10).

FIG. 11 is a graph showing T-cell response against hTERT overlappingpeptide library in a pancreas cancer patient following vaccination withDC transfected with hTERT mRNA. The results shown are for the samepatient as in FIG. 1.

FIG. 12 is a graph showing T-cell response against hTERT overlappingpeptide library in a lung cancer patient following vaccination with DCtransfected with hTERT mRNA.

FIG. 13 is a graph showing spontaneous T-cell response against hTERToverlapping peptide library in a third melanoma patient who had not beenvaccinated.

FIG. 14 is a graph showing a summary of the results from FIGS. 7 to 13for selected hTERT peptides.

FIG. 15 is a graph showing T-cell responses against selected hTERTpeptides in four lung cancer patients.

FIG. 16 is a graph showing T-cell responses against selected hTERTpeptides in six melanoma cancer patients.

FIG. 17 is a scatter plot showing the number of months' survival foreach patient against the number of peptides inducing an immune response.

FIG. 18 is a graph showing survival for the different patients testedand split into two groups depending on their immune responses againstthe peptide sequences against selected hTERT peptides. Those respondingagainst 0-1 peptides in addition to GV1001 were placed in one group andthose responding against 2 or more peptides were placed in the othergroup. Survival was analysed for the two groups using an independentgroup t-test. A preliminary test for equality of survival indicates thatthe survival of the two groups is significantly different. Therefore atwo-sample t-test was performed that does not assume equal survival.Using the unequal variances t-test, t(6,1)=−3.22, p=0.018. Statisticswere performed using WINKS SDA Software (Texasoft, Cedar Hill, Tex.)Statistical decisions were made at p=0.05. For these data, the Mean(SD)survival for the group 0-1 peptides is 10.7(3.9455), N=10, and theMean(SD) for the group 2 peptides is 51.5714(33.3909), N=7.

DETAILED DESCRIPTION OF THE INVENTION

In general terms, the invention relates to a polypeptide of thetelomerase protein which comprise a sequence selected from SEQ. ID NOS.2, 3, 4, 7, 8 and 9, wherein the polypeptide is less than 100 aminoacids in length and does not comprise the sequence of polypeptide GV1001(i.e. SEQ. ID NO. 10), SEQ. ID NO. 56 (reported by Schroers et al. 2002)any of SEQ ID NOS. 46, 57 or 59 to 61 (reported in WO03/038047) or SEQID NO. 62 (reported in WO00/02581). The polypeptide also does notconsist of the sequence of SEQ ID NO, 58 (reported in WO03/038047),

Particularly preferred polypeptides comprise the sequence of SEQ. ID NO.1 (which incorporates the sequences of SEQ. ID NOS. 2 and 3) SEQ. ID NO.6 (which incorporates the sequences of SEQ. ID NOS. 8 and 9) and SEQ. IDNO. 7.

In some embodiments, the polypeptides consist of the sequences set outin one of SEQ. ID NOS. 1 to 9. In other embodiments, the polypeptidescomprise one of the sequences set out in one of SEQ. ID NOS. 1 to 9 andany additional amino acids at the N and/or C termini are different fromthose present in the naturally occurring telomerase enzyme.

In other embodiments, there are provided immunogenic fragments of theaforementioned polypeptide, which fragments comprise at least eightamino acids and wherein the fragments are not any of the polypeptides ofSEQ. ID NOS. 6 or 11 to 16 nor are the fragments polypeptides having thesequence of SEQ. ID NO. 56. Exemplary immunogenic fragments includethose set out in SEQ. ID NOS. 17 to 40, which are predicted to havebinding affinity for MHC molecules of certain HLA class I alleles. It isto be appreciated that the polypeptides of SEQ. ID NOS. 17 to 40 are allimmunogenic fragments of the polypeptide of SEQ. ID NO, 1.

The sequence of the human telomerase enzyme (hTERT) is set out inGenBank accession no. AF015950. It is to be noted that each of SEQ. IDNOS. 1 to 9 is present within the amino acids at positions 660 to 705 ofthe telomerase enzyme. This corresponds to the active site of the humantelomerase reverse transcriptase subunit. It is believed that, once animmune response to epitopes in this region of the reverse transcriptasesubunit is elicited, any cells in a tumour in which the section of thetelomerase gene encoding this region were mutated, and which couldthereby avoid the immune response, would also have compromised theenzymatic activity of the encoded telomerase protein. Thus by targetingthis region of the telomerase enzyme, it is less likely that a colony ofcancerous cells could survive by mutation of the telomerase gene.

In some embodiments, a plurality of polypeptides as defined above arecovalently linked with each other to form a large polypeptide or even acyclic polypeptide.

In the above described embodiments of the invention, a polypeptide of asingle sequence is provided. However, in other embodiments, a cocktail(i.e. a mixture) of polypeptides is provided where the cocktailcomprises at least two different polypeptides comprising sequences fromSEQ. ID NOS, 2 to 7. In some embodiments the cocktail comprisesimmunogenic fragments of said polypeptides, wherein the immunogenicfragments comprise at least eight amino acids. The polypeptides are lessthan 100 amino acids in length.

It is particularly preferred that the polypeptides in the cocktailcomprise the sequences of SEQ. ID NOS. 1, 7, 8 or 9. It is especiallypreferred that the polypeptides in the cocktail comprise the sequencesof SEQ. ID NOS, 1, 7 and 9; SEQ. ID NOS, 1, 8 and 9; or SEQ. ID NOS. 1,8 and 10. It is thus within the scope of the invention that one of thepolypeptides in the cocktail comprises the sequence of SEQ. ID NO. 10(i.e. the sequence of the peptide referred to as GV1001). It ispreferred that the immunogenic fragments are those of SEQ. ID NOS. 17 to40.

It is preferred that the at least two polypeptides are different in thesense of being based on different sequences selected from SEQ. ID NOS. 1to 10.

It is particularly preferred that in the cocktail of polypeptides, thepolypeptides in the cocktail are capable of being bound by MHC moleculesof more than one HLA allele. For example, in one embodiment, thecocktail comprises a first polypeptide that is capable of being bound byMHC molecules of allele HLA-A*0201 and a second polypeptide that iscapable of being bound by MHC molecules of allele HLA-A-A*03. It is alsoto be understood that in some embodiments the cocktail comprises morethan two polypeptides having different sequences (e.g. 3, 4 or 5polypeptides).

In further embodiments, the or each polypeptide provided does not haveexact sequence identity to one of the aforementioned polypeptides.Instead, the polypeptide has at least 80% sequence identity to thepolypeptide set out above. It is particularly preferred that thesequence has at least 90%, 95% or 99% sequence identity to that set outabove. It is also preferred that any addition or substitution of aminoacid sequence results in the conservation of the properties of theoriginal amino acid side chain. That is to say the substitution ormodification is “conservative”.

Conservative substitution tables providing functionally similar aminoacids are well known in the art. Examples of properties of amino acidside chains are hydrophobic amino acids (A, I, L, M, F, P, W, Y, V),hydrophilic amino acids (R, D, N, C, E, Q, G, H, K, S, T), and sidechains having the following functional groups or characteristics incommon: an aliphatic side-chain (G, A, V, L, I, P); a hydroxyl groupcontaining side chain (S, T, Y); a sulphur atom containing side-chain(C, M); a carboxylic acid and amide containing side-chain (D, N, E, Q);a base containing side-chain (R, K, H); and an aromatic containingside-chain (H, F, Y, W). In addition, the following eight groups eachcontain amino acids that are conservative substitutions for one another(see e.g. Creighton, Proteins (1984):

1) Alanine (A), Glycine (G);

2) Aspartic acid (D), Glutamic acid (E);

3) Aspargine (N), Glutamine (Q)

4) Arginine (R), Lysine (K);

5) Isoleucine (I), Leucine (L), Methionine (M), Valine (V);

6) Phenylalanine (F), Tyrosine (Y), Tryptophan (W);

7) Serine (S), Threonine (T); and

8) Cysteine (C), Methionine (M),

In some embodiments, the sequence of the or each polypeptide is alteredin order to change (e.g. increase) the binding affinity of a polypeptideto an MHC molecule of a particular HLA allele. In other embodiments, thepolypeptide has further amino acids, in addition to those set out above,at the N- and/or C-terminal thereof. Such additional amino acids canalso be used to alter (e.g. increase) the binding affinity of apolypeptide to an MHC molecule.

It is necessary that the or each polypeptide (in particular apolypeptide whose sequence has been altered as set out above) is able toinduce a cytotoxic T-lymphocyte (“CTL”) response. That is to say thepolypeptide should be able to induce CTLs when the polypeptide ispresented by antigen presenting cells (e.g. dendritic cells).

Confirmation of CTL inducibility can be accomplished by inducingantigen-presenting cells carrying human MHC antigens (for example,B-lymphocytes, macrophages or dendritic cells) or more specificallydendritic cells derived from human peripheral blood mononuclearleukocytes, and after stimulation with the polypeptides, mixing withCD8+ cells, and then measuring the IFN-gamma produced and released byCTL against the target cells. As the reaction system, transgenic animalsthat have been produced to express a human HLA antigen (for example,those described in BenMohamed L, Krishnan R, Longmate J, Auge C, Low L,Primus J, Diamond D J, Hum Immunol 61(8): 764-79, 2000 August, RelatedArticles, Books, Linkout Induction of CTL response by a minimal epitopevaccine in HLA A*0201/DR1 transgenic mice: dependence on HLA class IIrestricted T(H) response) can be used. For example, the target cells canbe radiolabeled with ⁵¹Cr, and cytotoxic activity can be calculated fromradioactivity released from the target cells. Alternatively, CTLinducibility can be examined by measuring IFN-gamma produced andreleased by CTL in the presence of antigen-presenting cells that carryimmobilized peptides, and visualizing the inhibition zone on the mediausing anti-IFN-gamma monoclonal antibodies.

In some further embodiments of the present invention, the or eachpolypeptide is linked to other substances, while retaining theircapability of inducing a CTL response. Such other substances includelipids, sugar and sugar chains, acetyl groups, natural and syntheticpolymers and the like. The polypeptide, in certain embodiments, containsmodifications such glycosylation, side chain oxidation orphosphorylation.

In some embodiments, the or each polypeptide is produced by conventionalprocesses known in the art. Alternatively, the polypeptide is a fragmentof a telomerase protein produced by cleavage, for example, usingcyanogen bromide, and subsequent purification. Enzymatic cleavage mayalso be used. In further embodiments, the polypeptide is in the form ofa recombinant expressed polypeptide. For example, a suitable vectorcomprising a polynucleotide encoding the polypeptide in an expressibleform (e.g. downstream of a regulatory sequence corresponding to apromoter sequence) is prepared and transformed into a suitable hostcell. The host cell is then cultured to produce the polypeptide ofinterest. In other embodiments, the polypeptide is produced in vitrousing in vitro translation systems.

In an alternative embodiment of the present invention, there is provideda nucleic acid molecule consisting of a nucleotide sequence encoding apolypeptide as set out above.

In further embodiments of the present invention, there is provided acocktail (that is to say a mixture) of nucleic acid molecules whereinthe cocktail comprises at least two different nucleic acid moleculescomprising a nucleotide sequence encoding a polypeptide of the sequenceof SEQ. ID NOS. 2 to 7. In alternative embodiments, the polypeptide is afragment of one of SEQ. ID NOS. 2 to 7 comprising at least eight aminoacids. In alternative variants, the sequence of the polypeptide is notidentical to that aforementioned but instead has at least 80% sequenceidentity thereto. In any case, the polypeptide is less than 100 aminoacids in length. It is preferred that the encoded polypeptide comprisesthe sequence of SEQ. ID NOS. 1, 7, 8 or 9. It is especially preferredthat the encoded polypeptides in the cocktail comprise the sequences ofSEQ. ID NOS. 1, 7 and 9; SEQ. ID NOS. 1, 8 and 9 or SEQ. ID NOS. 1, 8and 10. In some embodiments, one encoded polypeptide thus comprises thesequence of SEQ. ID NO. 10 (i.e. the sequence of the GV1001 peptide). Itis also preferred that the immunogenic fragments that are encoded are ofthe sequences of SEQ. ID NOS. 17 to 40. It is preferred that the atleast two nucleic acid molecules are different in the sense of beingbased on different sequences selected from SEQ. ID NOS. 1 to 10.

It is to be appreciated that, owing to the degeneracy of the geneticcode, nucleic acid molecules encoding a particular polypeptide may havea range of polynucleotide sequences. For example, the codons GCA, GCC,GCG and GCT all encode the amino acid alanine.

The nucleic acid molecules may be either DNA or RNA or derivativesthereof.

In further embodiments of the present invention, there is apharmaceutical composition which comprises a polypeptide, a nucleic acidmolecule or a cocktail of polypeptides or nucleic acid molecules asdescribed above. In addition, the pharmaceutical composition comprises apharmaceutically acceptable adjuvant, diluent or excipient. In certainembodiments the pharmaceutical composition comprises a mixture of apolypeptide of the invention and a nucleic acid molecule of theinvention.

Exemplary adjuvants include Freund's complete or incomplete adjuvant,aluminium phosphate, aluminium hydroxide, alum, cholera toxin andsalmonella toxin. A particularly preferred adjuvant is GM-CSF(granulocyte macrophage colony stimulating factor). Exemplary diluentsand excipients include sterilised water, physiological saline, culturefluid and phosphate buffer.

The polypeptide or nucleic acid molecule is, in certain embodiments,coupled to an immunogenic carrier. Exemplary immunogenic carriersinclude keyhole limpet haemocyanin, bovine serum albumin, ovalbumin andfowl immunoglobulin.

The pharmaceutical composition, in some embodiments, also comprises afurther therapeutic ingredient. Exemplary further therapeuticingredients include interleukin-2 (IL2), interleukin-12 (IL12), afurther telomerase polypeptide (that is to say a polypeptide of thetelomerase enzyme aside from those discussed above) chemotherapeutics,pain killers, anti-inflammatory agents and other anti-cancer agents.

In some embodiments the pharmaceutical composition comprising apolypeptide is provide in the form of a lipopeptide conjugate which isknown to induce a high-affinity cytotoxic T-cell response (Deres, 1989,Nature 342),

Further details of additional components of the pharmaceuticalcomposition may be found in Remington's Pharmaceutical Sciences and USPharmacopoeia, 1984, Mack Publishing Company, Easton, Pa., USA.

In use, the polypeptide, nucleic acid molecule, the peptide cocktail,nucleic acid molecule cocktail or pharmaceutical composition, asexplained above (hereinafter, the “medicament”) is administered to apatient in need of treatment. Alternatively, the product is administeredto an individual prior to any symptoms of cancer in order to provideprotective immunity against cancer.

In embodiments in which the medicament comprises a polypeptide, thepolypeptide is endocytosed by antigen presenting cells, may be subjectto antigen processing and is then presented in complex with an MHC classI or class II molecule on the cell surface. Through interaction withT-cell receptors on the surface of T-cells, a CD4+ or CD8+ T-cellresponse is elicited. In embodiments in which the medicament comprises anucleic acid molecule, the nucleic acid molecule is also endocytosed andis then transcribed (if the nucleic acid molecule is DNA), and theencoded polypeptide is synthesised through endogenous cellular pathways.Subsequently, the encoded polypeptide is processed and presented on anMHC molecule in order to elicit the T-cell response, as previouslydescribed. Thus the medicament may be used as a vaccine in order toelicit either CD4+ or CD8+ T-cell immunity.

In principle, any mode of administration of the medicament may be usedbut injection is particularly preferred. For example the medicament maybe injected directly into a tumour in a patient. However, if the cancerto be treated is in the nose or mouth of a patient then in someembodiments the medicament is administered by spray and inhalation.

A suitable dosage for the medicament is from 50-200 μg although dosagesoutside this range may occasionally be required (e.g. from 1-500 μg). Adosage of between 100 and 150 μg is particularly preferred. Themedicament is, in some embodiments, administered to the patient weeklyor monthly. In certain embodiments, an “aggressive” treatment regimen ispursued which comprises three administrations of the medicament in thefirst week of treatment, then weekly administrations for a month, thenmonthly administrations for six months followed by a singleadministration every six months.

In principle, the medicament may be admitted to a patient suffering fromany type of cancer in which the telomerase gene is activated. Suchcancers include but are not limited to breast cancer, prostate cancer,pancreatic cancer, colorectal cancer, lung cancer, malignant melanoma,leukaemias, lymphomas, ovarian cancer, cervical cancer and biliary tractcarcinomas. As previously stated, the telomerase enzyme is expressed inthe vast majority of cancers so the efficacy of the medicament of thepresent invention is not limited to any particular type of cancer.

It is to be appreciated that, depending upon the class of T-lymphocyteresponse to be elicited, different lengths of polypeptide are preferred.More specifically, in order to elicit a CD8+ T-cell response, thepolypeptide must be presented on MHC class I molecules which willtypically only bind polypeptides which are between 8 and 10 amino acidresidues in length. On the other hand, in order to elicit a CD4+ T-cellresponse, it is necessary for the polypeptide to be presented on an MHCclass II molecule for which the polypeptides may generally be longer,typically between 15 and 24 amino acid residues in length. It is to benoted that some of the polypeptides of the present invention (e.g. thepolypeptide of SEQ. ID NO. 1) are longer than would normally beaccommodated in either an MHC class I or class II molecule. Peptides ofthis length have been shown to induce more robust immune responses, e.gby groups working on HPV and cervical cancer vaccination (Welters et al,2008). Without wishing to be bound by theory, it is believed that suchpolypeptides, following their administration to a patient, areendocytosed by cells, subjected to proteolytic degradation in theproteasome and then presented on an MHC class I or class II molecule.Thus such polypeptides may give rise to an MHC class I and/or an MHCclass II restricted T-cell response. It is also to be appreciated thatlonger polypeptides remain extant within a patient for a greater periodof time than shorter polypeptides and therefore there is a longer periodof time during which they may elicit an immune response. This isparticularly significant as regards those polypeptides which have arelatively low MHC binding affinity.

It is also to be appreciated that the telomerase enzyme is a “selfprotein”, that is to say, the enzyme is a naturally-occurring protein inthe human body. Accordingly, individuals will generally have developedsome degree of immunological tolerance to polypeptides of the telomeraseenzyme through a process whereby T-cells reactive with such polypeptidesare destroyed in the thymus of the individual during T-cell development.Thus in some embodiments of the present invention, polypeptides of thepresent invention with a relatively low MHC binding affinity aredesired. This is because polypeptides with lower MHC binding affinitywill have been exposed to maturing T-cells at a lower rate and so it isless likely that all of the individual's T-cells reactive with thepolypeptide will have been deleted from the individual's T-cellrepertoire. Thus polypeptides having a relatively low MHC bindingaffinity are, in some embodiments, able to overcome immunologicaltolerance more readily.

In some embodiments of the invention, the administration of one of thepolypeptides of the invention results in “epitope spreading” whereby animmune response is elicited against other polypeptides of the telomeraseprotein which are adjacent to the administered polypeptide in thetelomerase protein.

EXAMPLES Example 1

hTERT epitopes that were recognized by a patient's T cells followingvaccination with hTERT transfected DCs were characterised. Vaccinationresulted in a diverse and broad immune response involving both CD4+ Thcells and CD8+ T cells. This response is believed to be responsible forthe tumour regression and long term survival observed in the patient.

Material and Methods

Patient

A 62-year old woman with recurrent ductal adenocarcinoma of the pancreaswas vaccinated with dendritic cells loaded with hTERT mRNA on acompassionate use basis. The treatment was approved by the NorwegianMedicines Agency and the Regional Committee for Medical Research Ethics.It was performed in compliance with the World Medical AssociationDeclaration of Helsinki. Written informed consent was obtained from thepatient.

Production of mRNA-Transfected DCs

DCs were generated as described earlier (Kyte et al, 2006 and Mu L J etal 2003). Briefly, monocytes obtained from leukapheresis product werecultured for 5 days with granulocyte-macrophage colony-stimulatingfactor (GM-CSF) and interleukin-4 (IL-4). The resulting immature DCswere transfected with hTERT-mRNA by square wave electroporation (Kyte etal, 2006, Sæbøe-Larssen S et al 2002) and then cultured for 2 days withcytokines facilitating maturation (interleukin-1 β (IL-1β),interleukin-6 (IL-6), tumor necrosis factor α (TNFα) and prostaglandinE₂ (PGE2)). To obtain adequate control DCs, a fraction of the DCs wasmock-transfected, i.e. electroporated without mRNA. The DC phenotype wasevaluated by flow cytometry, as previously described (Kyte et al, 2006).The DCs had a mature DC phenotype, expressing HLA class II, CD86 andCD83, but not CD14. The DC viability was >85%, as assessed by trypanblue staining.

The second and third vaccine batch were fast DC (Alldawi et al 2005,Tanaka et al 2006, Ho et al 2006). Monocytes were cultured for 2 dayswith GM-CSF and IL-4, then matured for 1 day in the same way as forconventional DC before electroporation. The DCs were then left overnightbefore being frozen.

Vaccine

The vaccine consisted of 5×10° autologous monocyte-derived dendriticcells loaded with hTERT mRNA. The patient received 4 weekly injectionsfollowed by monthly booster injections.

Clinical Monitoring

Adverse events were recorded and graded according to the NCI-commontoxicity criteria, as previously reported (Kyte et al, 2006 Genetherapy). Only minor side effects were observed, with no treatmentrelated grade III-IV toxicity. Objective tumour response was assessed byclinical examination and CT scans prior to start of vaccination andevery 3 months during the vaccination. The tumour response wasclassified according to the Response Evaluation Criteria in Solid Tumors(RECIST) (Therasse P et al, 2000).

DTH

Immunomonitoring

Peripheral blood mononuclear cells (PBMCs) were obtained prior to thefour standard vaccinations, after 5 weeks and after 12 weeks. PBMCs werealso obtained before each monthly booster vaccination. The PBMCs wereisolated and frozen as previously described (Kyte et al, 2005). ThawedPBMCs were stimulated once in vitro with tDCs (not with mockDCs) andcultured and then tested in T cell proliferation assays (³H Thymidine)as previously described (Kyte et al 2006). The T cells were tested intriplicates. Irradiated tDCs and mock-transfected DC controls (mockDCs)were used or PBMC with or without hTERT peptide as APCs. Negativecontrols with T cells only were included.

PBMCs from various time points were stimulated with an overlapping hTERT15-mer peptide library or a 30-mer hTERT peptide, all from ProImmune andthen tested in proliferation assays as above using irradiated PBMCs asAPCs as described in (Bernhardt et al 2006).

Flow Cytometry

Pentamer staining was performed on fresh or frozen patient PBMCs.Phycoerythrin-conjugated pentamers were manufactured by ProImmune andtested for non-specific staining on HLA-A2 positive T-cell linesspecific for Choriomeningitis Virus (CMV) peptide NLVPMTATV.Manufacturer's recommended working concentration was used. Pentamer withHIV peptide SLYNTVATL-A*0201 was used as a negative control. Cells werestained with pentamers for 10 min at room temperature (RT), washed instaining buffer consisting of phosphate buffered saline (PBS) containing0.1% Human serum albumin (HSA) and 0.1% sodium azide. Cells were thenstained anti-CD4-Fluorescein isothiocyanate (FITC), anti-CD19-FITC(eBioscience), anti-CD8-PerCP and anti-CD3-Pacific Blue (PB)(eBioscience) for 15 min at RT, washed once in staining buffer andresuspended in the same buffer before acquisition. For intracellularstaining, 12-day peptide stimulated T cells were stimulated overnight inthe presence of Brefeldin A (BD Bioscience) at 10 ug/ml and BDGOLGISTOP® (a protein transport inhibitor containing monensin) (BDBiosciences) at a 1/1000 dilution with an autologous Epstein BarrVirus-transformed B lymphoblastoid cell lines (EBV-LCL) loaded withpeptide at a T cell to target ratio of 5:1. Non-peptide loaded targetcells and T cells alone were used as negative controls. Cells were thenstained for CD3 (eBioscience), CD4, CD8, IFN- (eBioscience), IL-2 andTNF-α using the BD Cytofix/Cytoperm kit according to the manufacturer'sinstructions. Finally, cells were resuspended in staining buffercontaining 1% paraformaldehyde. All antibodies and all reagents forintracellular cytokine staining were purchased from BD Pharmingen exceptwhere noted. 250,000 lymphocytes were acquired per sample using a BD LSRII flow cytometer and data was analyzed using FLOWJO® (a softwarepackage for analyzing flow cytometry data) software (Treestar Inc.,Ashland, Oreg., USA).

Results

The patient experienced disease stabilization on gemcitabine treatment,but after 5 months the treatment was suspended due to adverse effects.She was then offered DC vaccination as an alternative treatment. After18 months of vaccination she experienced complete remission which ismaintained after 30 months of vaccination (44 months post diagnosis).The patient was re-diagnosed and examined by an independent pathologistwho confirmed the diagnosis of ductal adenocarcinoma.

The median survival for inoperable pancreas cancer patients is 8-10months, which in this case is far exceeded. The first vaccine batchconsisted of 5×10⁶ conventional DCs (Kyte et al 2006) and the patienthad 15 vaccines administered. Due to the demonstration of an immuneresponse against the vaccine and stable disease new vaccine batches weremade and batches 2 and 3 were fast DC and 10 and 17 vaccines,respectively, of 5×10⁶ DCs loaded with hTERT mRNA were administered.

A proliferative T-cell response to the DC vaccine could be measured invitro 3 months post vaccination and stabilized from month 6. Havingdocumented the presence of an immune response to hTERT transfected DCs,it was desired to investigate which hTERT epitopes were responsible forinducing the immune response. This was tested by measuring T-cellproliferation to a hTERT peptide library (FIG. 1) and ex vivo pentamerstaining of PBMCs.

Proliferative T-cell responses were detected in six of the 15-mer hTERTpeptides from the overlapping peptide library and a 30-mer hTERTpeptide. The presence of hTERT-pentamer positive CD8+ T cells wasdetected both pre- and post-vaccination with percentages ranging from0.15% to 1.25% in non-stimulated PBMCS A population of 1.25% of the CD8+T cells was shown to be pentamer-positive in fresh PBMCs 24 months postvaccination (FIG. 2A) and increased to approximately 3% after in vitropeptide stimulation (data not shown).

After one round of in vitro stimulation with the 30-mer hTERT peptidecontaining at least two T helper epitopes as well as the CTL epitopes inthe 720GLL-pentamer, we could detect a small population ofmultifunctional CD4+ T cells, secreting IFN-γ, IL-4 and TNF-α inresponse to autologous EBV-transformed B-cells loaded with the samepeptide. There was no difference in the CD8+ T cell population afterstimulation with the peptide-loaded target cells compared with thosestimulated with non-peptide loaded targets (data not shown). Highbackground levels of IL-2 seen may be due to some stimulation given bythe transformed B cell line which could express hTERT. Unfortunately,due to the limited amount of T cells in each experiment additionalfunctional assays could not be performed.

Discussion

In this Example, there is reported a pancreas cancer patient with anextraordinary disease course following treatment with chemotherapy andvaccination with autologous DC transfected with hTERT mRNA.

The patient described here has survived for more than 4 years with arelapsing pancreatic adenocarcinoma following radical surgery. Toconfirm that the original diagnosis was correct the primary tumour wasre-diagnosed by an independent pathologist.

Following radical surgery in January 2006 the patient relapsed inDecember 2006 with enlarged lymph nodes localized in liver hilus,truncus iliacus and in the retroeritoneum as assessed by CT.

The patient responded well to chemotherapy and CT scans revealed tumourshrinkage. However, after 5 months with chemotherapy the patientdeveloped severe adverse effects and the treatment was stopped.

In this clinical setting, the patient was offered treatment withautologous DC loaded with hTERT mRNA vaccination on a compassionate usebasis in order to consolidate the beneficial effect of the chemotherapy.

Interestingly, rather than developing progressive disease afterchemotherapy ended, a long term disease stabilization and potentiallycomplete remission was obtained. Two consecutive PET scans 6 monthsapart, revealed a metabolically silent tumour tissue at the site ofpancreatic and metastatic lesions. These intriguing findings indicatethat the immunotherapeutic strategy used has induced a clinicallyrelevant immune response in this patient. It was therefore important todocument and study in depth the immune response against hTERT in thepatient. Furthermore, as there is a complete lack of informationregarding the detailed immune response to hTERT from studies using fulllength hTERT mRNA for vaccination, it is important to identifyclinically relevant hTERT epitopes for the development of the nextgeneration of hTERT vaccines.

A high frequency of CD8+ T cells binding pentamers with new CTL epitopeswas found. These two epitopes were HLA-A*0201 restricted and have notbeen previously described. Interestingly, the 9-mer epitope (720GLL,SEQ. ID NO. 3) is embedded in a 15-mer peptide (720,PGLLGASVLGLDDIH—SEQ. ID NO. 55) which is the same length as peptide R672(SEQ. ID NO. 56) previously described by Schroers et al 2002, butshifted one amino acid towards the C-terminus of hTERT. It is possible,therefore, that the same amino acid residues within both 15-mer peptidesare responsible for the T-cell response. Importantly, the same 15-merpeptide (720) was also recognized by T cells from the patient reportedhere in the proliferation assays, indicating that this peptide fragmentof hTERT may have elicited both a CD4+ and a CD8+ T cell response inthis patient. Moreover, five other 15-mer peptides were recognized by Tcells from this patient. Three of these peptides have not previouslybeen reported. Taken together, these results demonstrate that thisvaccine has induced T-cell responses to at least 10 different hTERTepitopes in this patient. The number of epitopes may be considerablygreater as only a limited number of peptides were used from anoverlapping peptide library not covering the whole sequence as well onlya few pentamers limited to HLA-A*0201 presented peptides.

This indicates that there is no widespread tolerance against hTERTpeptides and that the vaccination strategy using hTERT mRNA transfectedDCs is highly potent.

The above results also demonstrate that T cells from this patient,capable of recognizing a 30-mer hTERT peptide encompassing two of the15-mer and one 9-mer peptide, produce three Th1-associated cytokinessimultaneously. This kind of multifunctionality has previously beendemonstrated to give better protection against infection. Darrah et al,2007 showed that the degree of protection against Leishmania majorinfection in vaccinated mice is predicted by the frequency of CD4⁺ Tcells simultaneously producing interferon-γ (IFN-, interleukin-2 andTNF-α).

The very unusual clinical course of this patient indicates that thevaccination and the resulting immune response may have had an impact onthe tumour and the metastases. This is highly conceivable as it has beendemonstrated that a broad and composite immune response against hTERTwas elicited by the hTERT mRNA DC vaccine. As a result an immune attackon remaining tumour cells may have involved direct killing of tumourcells by hTERT-specific CTLs, T helper cell cytokine production (IFN-γ,TNF-α) effects on cancer cells and tumour-associated stroma and tumourneovasculature and amplification of an ongoing spontaneous immuneresponses against other tumour antigens present in the adenocarcinoma.This can take place when hTERT-specific Th cells encounter MHC class IIpositive antigen presenting cells that have taken up tumour antigens insitu or in tumour draining lymph nodes.

Example 2

One stage IV lung cancer patient was vaccinated with autologousmonocyte-derived DC transfected with mRNA encoding hTERT to investigatethe safety, tolerability and immunological response prior to the startof a new phase I/II clinical trial. The patient first received fourweekly vaccinations followed by monthly booster vaccinations of 5×10⁶ DCinjected intradermally. Peripheral blood mononuclear cells (PBMC) wereobtained prior to the four standard vaccinations, after 5 weeks, 12weeks and monthly thereafter. Thawed PBMC were stimulated in vitro withtransfected DC. T-cell proliferation assays were performed withirradiated transfected DC and mock-transfected as DC controls. Inaddition, hTERT-specific CD8+ T cells were monitored by pentamerstaining. The treatment was well tolerated with minor side effects andthe patient experienced prolonged survival (72 weeks) compared with whatwould be expected (12 weeks). The patient showed specific T-cellproliferation in response to the mRNA-loaded DC in vitro aftervaccination. Stable populations of hTERT-specific CD8+ T cells weredetected by pentamer staining in post-vaccination samples. Samples fromdifferent time points post vaccination were further tested against apanel of 24 overlapping hTERT peptides and T-cell responses againstmultiple peptides were detected (FIG. 12). T-cell responses to theseepitopes have also been identified both in non-vaccinated cancerpatients and cancer patients previously vaccinated with the GV1001telomerase peptide (SEQ. ID NO. 10), which indicates a high degree ofimmunogenicity and HLA promiscuity. These clinical experiences inExamples 1 and 2 show that vaccination with hTERT-mRNA transfected DC issafe and able to induce robust immune responses to several telomeraseT-cell epitopes both in 004+ and 008+ T cells.

Example 3

Peptides of the telomerase enzyme suitable for eliciting T-cellresponses were identified and ranked by examining data from severalvaccinated patients (vaccinated with either the GV1001 peptide or withdendritic cells transfected with mRNA encoding hTERT) and anon-vaccinated cancer patient, to identify peptides that would be ableto induce useful anti-tumour immune responses. A summary of the selectedpatients, their vaccination status and their clinical response isprovided in Table 9. In one patient vaccinated with GV1001 (SEQ. ID NO.10), the T-cell response to peptide 660-689 (30-mer) (SEQ. ID NO. 1) iseven stronger than to the vaccine peptide itself at certain time points(see FIG. 3), but also the other patients show robust immune responsesto this peptide. The peptides identified are set out in Table 1. T cellresponses against these peptides were not found in any of six normalblood donors that were tested for reactivity.

TABLE 1 No. of Former amino SEQ. Peptide Peptide acids in ID NO. NamePeptide Sequence Name peptide 1 660-689 ALFSVLNYERARRPGLLGASVLGLDDIHRA719-20 30 2 663-677 SVLNYERARRPGLLG 719 15 3 674-683 GLLGASVLGL 720GLL10 4 615-624 ALLTSRLRH 615ALL 10 5 613-621 RPALLTSRL 613RPA  9 6 653-661RLTSRVKAL 728RLT  9 7 691-705 RTFVLRVRAQDPPPE 725 15 8 653-667RLTSRVKALFSVLNY 718 15 9 651-665 AERLTSRVKALFSVL 728 15

T-cell clones specific for all of the peptides of 15- or 30-amino acidsshown in Table 1 have also been obtained from patients. These cloneshave been shown to recognize naturally processed peptides (data notshown) and respond to very low peptide concentrations down to 10 ng/ml(see FIG. 4), which means they have high affinity for their target. Thisis important in order to be able to induce strong immune response invivo where peptide concentrations are lower.

The 30-mer polypeptide of SEQ. ID NO. 1 has shown reactivity in nearlyall the cancer patients tested and therefore seems very immunogenic.This peptide contains both motifs that can be recognized by CD4+ Thelper cells like the GV1001 vaccine (SEQ. ID NO. 10) and also motifsrecognizable by CD8+ cytotoxic T lymphocytes (CTL). Both of these typesof responses have been detected in vitro in T lymphocytes from patientsstimulated with the peptide.

Using fluorochrome-tagged reagents (pentamers) able to bind CD8+ Tlymphocytes specific for the above-mentioned 9- or 10-mer peptides, thepresence of these cells has been detected in numerous cancer patients,mainly vaccinated with GV1001 (SEQ. ID NO. 10). These 9- or 10-merpeptides are recognized when presented on HLA-A2 molecules (FIG. 5)which are present in approximately 50% of the Caucasian population andon HLA-B7 molecules (FIG. 6) present in 20% of the same population,which means that together they cover the majority of the Caucasianpopulation.

In addition, the 15- and 30-mer peptides listed in Table 1 showreactivity in nearly all patients tested, which means they arepromiscuous with respect to the HLA class II alleles on which they arepresented and that they are applicable to nearly the whole populationwithout any need for HLA-screening (see Table 2).

TABLE 2 HLA Frequency Peptide class II in Cauca- Specific speci- Pa-allele sians clones ficity tients Cancer DR*01 22.6% T-cell 683-677 2Malignant melanoma lines DR*04 33.9% 3 653-667, 3 Malignant melanoma663-677 DR*07 30.1% 3 Part of 1 Colon cancer, Schroers 660-689 et al,2003 DR*08 4.3% >85  663-677 2 Malignant Melanoma and Lung cancer DR*142.9% 6 660-689 2 Colon cancer, Lung clones cancer

As well as inducing reactivity in patients vaccinated with GV1001 (SEQ.ID NO. 10), these peptides have also induced T-cell responses in cellsfrom one lung cancer and one pancreas cancer patient vaccinated withdendritic cells transfected with hTERT mRNA. The mRNA used will not givetranslation of the full-length hTERT protein, but covers the majority ofit, and the peptides listed in Table 1 induce some of the strongestresponses in these patients.

Example 4

T-cell responses to a hTERT peptide library (including the polypeptidesfrom Table 1) were determined for T-cells from 5 patients in addition tothe patients reported in Examples 1 and 2. The methods were the same aspreviously described in Example 1 or in Bernhardt et al 2006. In brief,PBMCs from various time points during vaccination were stimulated withthe overlapping hTERT peptide library prior to testing for specificT-cell responses in proliferation assays. The results are shown in FIGS.7 to 13. A complete list of peptides is shown in Table 3.

TABLE 3 Position Number of SEQ. in hTERT Former amino acids IDAmino acid Peptide in peptide NO. sequence Peptide sequence Namesequence 42 563-577 VTETTFQKNRLFFYR 710 15 43 573-587 LFFYRKSVWSKLQSI711 15 44 583-597 KLQSIGIRQHLKRVQ 712 15 45 603-617 EAEVRQHREARPALL 71315 46 613-627 RPALLTSRLRFIPKP 714 15 47 623-637 FIPKPDGLRPIVNMD 715 1548 643-657 RTFRREKRAERLTSR 717 15 49 653-667 RLTSRVKALFSVLNY 718 15  2663-677 SVLNYERARRPGLLG 719 15 50 683-697 LDDIHRAWRTFVLRV 721 15 51693-707 FVLRVRAQDPPPELY 722 15  5 721-735 PQDRLTEVIASIIKP 723  1 53578-592 KSVVVSKLQSIGIRQH 724 15  7 691-705 RTFVLRVRAQDPPPE 725 15  9651-665 AERLTSRVKALFSVL 728 15 54 593-608 LKRVQLRELSEAEVRQ 731 16  1660-689 ALFSVLNYERARRPGL 719-20 30 LGASVLGLDDIHRA  3 674-683 GLLGASVLGL720GLL 10  6 653-661 RLTSRVKAL 728RLT  9  4 615-624 ALLTSRLRFU 615ALL 10 5 613-621 RPALLTSRL 613RPA  9

The histograms in FIGS. 7 to 13 show responses against the hTERToverlapping peptide library in 7 patients (the pancreas cancer patientwas the one reported in Example 1),

Peptide 613-627 has a very similar sequence to GV1001 (SEQ. ID NO. 10)and is assumed to be recognized by the same cells that recognize GV1001,but peptide 613-627 is not identical to the vaccine peptide.

The last two patients have not been tested for responses against the30-mer 660-689 (SEQ. ID NO. 1) as this peptide was synthesized after thetests. The peptide of SEQ. ID NO. 1 gave very strong responses in theGV1001 vaccinated lung cancer patient. 75% of the T-cell clones derivedfrom the culture with this peptide were specific which indicates thatthis clone is present in the patient at a high frequency. This is thesame lung cancer patient whose hTERT-specific CD8+ T cells are shown inthe histogram of FIG. 6.

As the patients tested (except the non-vaccinated patient shown) havebeen selected due to their extraordinary clinical courses, the strongresponses detected against the peptides listed in Table 1 indicate thatthese peptides are clinically relevant epitopes.

Example 5

The sequence of the polypeptide of SEQ. ID NO. 1 (the 30-mer 660-689)was analysed for immunogenic fragments predicted to bind different HLAclass I alleles (prediction is performed using the SYFPEITHI databasefor MHC ligands and peptide motifs). The results are shown in Table 4.

TABLE 4 SEQ. ID Peptide Peptide No. amino Predicted binding  NO.Sequence Position acids to HLA class I alleles  3 GLLGASVLGL 674-683 10HLA-A*0201, HLA-A*03 17 VLGLDDIHRA 680-689 10 HLA-A*0201, 18 GASVLGLDDI677-686 10 HLA-A*0201, 19 ALFSVLNYER 663-672 10 HLA-A*0201, HLA-A*03,HLA-A*1101 20 SVLNYERARR 663-672 10 HLA-A*03, HLA-A*1101, HLA-A*6801 21SVLGLDDIHR 679-688 10 HLA-A*03, HLA-A*1101, HLA-A*6801 22 FSVLNYERAR662-671 10 HLA-A*1101 23 NYERARRPGL 677-675 10 HLA-A*2402 24 YERARRPGLL667-676 10 HLA-B*4402, HLA-B*18 25 RPGLLGASVL 672-681 10HLA-B*0702, HLA-B*5101 26 ERARRPGLL 668-676  9 HLA-A*26, HLA-B*1402,HLA-B*2705, HLA-B*2709, HLA-B*08 27 VLGLDDIHR 680-688  9 HLA-A*6801 28SVLNYERAR 663-671  9 HLA-A*6801, HLA-A*0 29 VLNYERARR 664-672  9HLA-A*6801, HLA-A*03 30 ARRPGLLGA 670-678  9 HLA-B*1402, HLA_B*4501 31PGLLGASVL 673-681  9 HLA-B*1402, HLA-B*5101, HLA-B*2705 12 LLGASVLGL675-683  9 HLA-B*1402 11 YERARRPGL 667-675  9 HLA-B*18, HLA-B*37, HLA-B*4001, HLA_B4402, HLA- B*4901, HLA-B*08 32 RRPGLLGAS 671-679  9HLA-B*2705 33 ALFSVLNYE 660-668  9 HLA-A*0201, 34 GLLGASVLG 674-682  9HLA-A*0201, HLA-A*03 35 SVLGLDDIFI 679-687  9 HLA-A*03 36 ERARRPGL668-675  8 HLA-B*1402, HLA-B*08 37 ARRPGLLG 670-677  8 HLA-B*1402 38GLLGASVL 674-681  8 HLA-B*1402, HLA-B*08 39 RARRPGLL 669-676  8HLA-B*5101, HLA-B*08 40 LGASVLGL 676-683  8 HLA-B*5101

Example 6

A comparison of the patients studied in Example 4 was carried out. Inbrief, seven patients were identified as clinical responders following acancer diagnosis and vaccination with an hTERT vaccine. These patientswere identified based on a combination of prolonged survival andclinical response. The clinical response could either be stable disease(SD), partial response (PR) or complete response (CR). The vaccinatedmelanoma patients were diagnosed with stage IV at the time of inclusionin the clinical trial, but had no brain metastases. Lung cancer patientP5 was diagnosed with stage IV, inoperable lung cancer and colon cancerpatient P1 with late stage inoperable colon cancer. Lung cancer patientP6 was a stage IV lung cancer patient with a 12-week life expectancy.Pancreas cancer patient P1 had relapsed, inoperable pancreas cancer anda life expectancy of 8-10 months. Four of the patients (designatedMelanoma P7-P8, Lung cancer P5 and Colon cancer P1) had each beenvaccinated with the peptide GV1001 (SEQ ID NO. 10). The fifth patient(designated Lung cancer P6) and the sixth patient (designated Pancreascancer 1) had been vaccinated with dendritic cells transfected with mRNAencoding hTERT. The seventh patient. Melanoma patient P9, had not beenvaccinated at the time of the study and instead developed a spontaneousresponse following development of the cancer. (An eighth and finalpatient was also identified as a clinical responder but samples fromthis patient were not available for study.)

The proliferative T-cell responses of each patient to a series ofpeptides were then determined as explained in Example 1 The results aretabulated in Table 5 and are shown graphically in FIG. 14 in which thepeptide designations are referenced in Table 6 (the results for peptides726 and GV1001 are shown only for comparison).

TABLE 5 hTERT peptides Patient 718 725 726 728 719-20 GV1001 Melanoma P74.8 4.9 5.8 3.2 44.5 76.5 Melanoma P8 6.3 2.8 0.9 1 5.7 13.2 Melanoma P94.2 5.7 3.7 5.9 6.9 1.7 Lung ca P5 0.8 1.1 31 1.2 44.5 20.1 Lung ca P62.1 0.8 0.6 0.7 2.5 7.1 Colon ca P1 2.6 20.6 4 13.9 27.2 105.1 Pancreasca P1 1.3 2.5 2.5 1 17.1 2.2

TABLE 6 Former peptide name SEQ ID NO. 719-20 1 725 7 718 8 728 9 GV100110

It was observed that all of the patients responded to GV1001 (i.e. theyhad SI>2). Due to high background caused by auto-MLC in the dendriticcell-vaccinated patients (Lung ca. P7 and Pancreas ca. P1) the SI valuesare low compared with those found in other patients,

Example 7

Four patients who were clinical non-responders following a lung cancerdiagnosis and a GV1001 (SEQ ID NO, 10) peptide vaccination were studied.These patients were all stage IV lung cancer patients vaccinated withGV1001. These patients were randomly selected amongst those patients whohad an immune response against GV1001 but still experienced progressivedisease and short term survival compared to other patients with animmune response against the vaccine. The proliferative T-cell responsesof each patient to a series of peptides were determined in the samemanner as in Example 1, at one time point. The peak response of eachpatient during the study period to peptide GV1001 is also shown whichconfirms that each patient responded immunologically to GV1001vaccination.

The results are tabulated in Table 7 and are shown graphically in FIG.15 and the peptide designations are referenced in Table 6.

TABLE 7 hTERT peptides Peak response Patient 718 725 726 728 719-20GV1001 GV1001 Lung ca P1 1.2 1.3 1.2 0.8 1 0.9 60.95 Lung ca P2 0.9 10.8 0.6 1.1 122.8 122.8 Lung ca P3 1.1 1.2 1.1 0.8 0.9 1.4 161.6 Lung caP4 1.1 0.4 1.1 0.7 1.5 1.2 13.3

All four of the patients showed very low or no response to the peptidesof SEQ ID NOS. 1, 7, 8 and 9.

Example 8

Six patients who were clinical non-responders following a melanomacancer diagnosis and a GV1001 peptide (SEQ ID NO. 10) vaccination werestudied. These patients were all stage IV melanoma patients and includedin the same GV1001 vaccination trial as melanoma patients P7 and P8 whowere long term survivors (see Example 6). These patients were randomlyselected amongst those who showed an immune response against thevaccine, but still experienced only short term survival. Five of thepatients also experienced progressive disease and one patient,designated Melanoma P3, experienced some stabilization of the diseasebut still had short survival. The proliferative T-cell responses of eachpatient to a series of peptides were determined in the same manner as inExample 1, at one time point. The peak response of each patient duringthe study period to peptide GV1001 is also shown which confirms thateach patient responded immunologically to GV1001 vaccination.

The results are tabulated in Table 8 and shown graphically in FIG. 16and the peptide designations are referenced in Table 6.

TABLE 8 hTERT peptides Peak response Patient 718 725 726 728 719-20GV1001 GV1001 Melanoma P1 0.9 0.9 0.9 0.8 1.6 1.4 26.0 Melanoma P2 0.8 11 0.6 5.3 0.9 38.7 Melanoma P3 0.6 0.7 0.5 0.5 0.3 1.8 3.7 Melanoma P41.1 1 1.2 0.8 1 1.2 10.7 Melanoma P5 7.1 1.2 1.9 0.9 1.9 25.2 35.4Melanoma P6 0.8 4.8 n.t. 1.3 1.8 21.4 122.0

All six of the patients showed very low or no response to the peptidesof SEQ ID NOS. 1, 7, 8 and 9.

Conclusion of Examples 1 to 8

A summary of the patients studied in Examples 1 to 8 is provided inTable 9. All patients responded immunologically to the GV1001 peptide.The patients were classed as either clinical responders or clinicalnon-responders based on their clinical response which included stabledisease (SD), tumour regression (PR or CR) and unexpectedly longsurvival time. Both clinical responders and clinical non-responders wereselected from the same or similar vaccination trials.

TABLE 9 Vaccine- specific T cell response at time-point SurvivalClinical Clinical Patient Cancer Vaccine tested (Months) responseResponder Lung ca P4 Lung cancer GV1001 Yes 10 PD No Lung ca P3 Lungcancer GV1001 Yes 20 PD No Lung ca P1 Lung cancer GV1001 Yes 14 PD NoLung ca P2 Lung cancer GV1001 Yes 6 PD No Melanoma P4 Melanoma GV1001Yes 8 PD No Melanoma P6 Melanoma GV1001 Yes 8 PD No Melanoma P5 MelanomaGV1001 Yes 12 PD No Melanoma P1 Melanoma GV1001 Yes 10 PD No Melanoma P3Melanoma GV1001 Yes 10 SD No Melanoma P2 Melanoma GV1001 Yes 9 PD NoMelanoma P7 Melanoma GV1001 Yes  65+ alive, PR Yes Melanoma P8 MelanomaGV1001 Yes 21 increased Yes TTP, PR Melanoma P9 Melanoma Spontaneous Yes 30+ alive, SD Yes response, non- vaccinated Lung ca P5 Lung cancerGV1001 Yes 106+ alive, CR Yes Lung ca P8 Lung cancer DC/ Yes 18 PR YeshTERT mRNA Colon ca P1 Colon GV1001 Yes  80+ alive, CR Yes cancerPancreas ca Pancreas DC/ Yes  43+ alive, CR Yes P1 cancer hTERT mRNA+signifies that the patient is still alive PD = Progressive disease SD =Stable disease PR = Partial response CR = Complete response TTP = timeto progression

The data presented here strongly indicate that administering any of thepeptides of SEQ. ID NOS. 1 to 9 to individuals will induce T-cellresponses to the administered peptide in at least some individuals. Thepresence of T-cell responses to the peptides of SEQ. ID NOS. 1 to 9 inpatients to whom other hTERT peptide vaccines or transfected dendriticcells have been administered demonstrates that the peptides of SEQ. IDNOS. 1 to 9 can be bound and presented by patients' MHC molecules andthat patients have T cells within their repertoires capable of bindingthe peptides when presented. Thus when the peptides of SEQ. ID NOS. 1 to9 are administered to individuals, T-cell responses to the peptides areto be expected,

Moreover, the data provided in Examples 6 to 8 demonstrate that T cellresponses against the hTERT peptides of SEQ ID NOS. 1, 7, 8 and 9described herein are associated with favorable clinical responses inpatients with different forms of cancer. In a number of short termsurvivors who had been treated in the same way by an hTERT vaccine andwho had responded to this vaccine, responses to the hTERT peptides ofSEQ ID NOS. 1, 7, 8 and 9 were only sporadically observed. It is alsonotable that in some of these short term survivors, the response to theGV1001 peptide was strong. We interpret these results to mean thatresponse to a single peptide (i.e. GV1001) alone is not sufficient toprovide clinical response/long term survival, since in the majority ofpatients with an immune response to this peptide, survival was short.

This is confirmed by the scatter plot analysis shown in FIG. 17 whichcompares the number of hTERT peptides to which patients demonstrated animmune response with the length of survival of the patients. As can beseen in FIG. 17, there is a clear correlation between longer survivaltimes and immune responses to a greater number of hTERT peptides.

In addition, the analysis shown in FIG. 18 demonstrates that thosepatients responding against 2 or more hTERT peptides in addition toGV1001 had an increased length of survival that was statisticallysignificant compared with those patients showing an immune response to 0or 1 hTERT peptides in addition to GV1001.

Furthermore, the data disclosed herein provide strong evidence pointingto a crucial role for the hTERT peptides of SEQ ID NOS, 1, 7, 8 and 9 inbeneficial immune responses. Therefore, active immunization with thesenovel peptides should induce clinically relevant immune responses in ahigher number of patients and thus result in prolonged survival in ahigher proportion of patients than is achievable by vaccination with theGV1001 peptide alone.

We demonstrate that responses against the peptides of SEQ ID NOS. 1, 7,8 and 9 arise naturally after vaccination with unrelated peptides inclinical responders contrary to the patients that do not do wellclinically. The mechanism behind this natural immunization is believedto be presentation of these peptides by antigen presenting cells thathave engulfed dead tumour cells carrying hTERT and processed the hTERTprotein by its proteolytic machinery to yield an array of naturallyprocessed hTERT peptides that correspond to the peptides of SEQ ID NOS,1, 7, 8 and 9 described herein. The demonstration that many of the samepeptides are recognized by T cells taken from patients that have beenimmunized by hTERT mRNA transfected antigen presenting cells (dendriticcells), and that these patients have done exceptionally well aftervaccination, further strengthen this notion. By boosting or inducingthese responses through vaccination with a peptide of the presentinvention or a cocktail of such peptides that have thus already beenclinically validated, it will be possible to induce clinical responsesand prolonged survival in a much larger proportion of patients.

Example 9

The results from Examples 1 to 8 were also examined for the mostefficacious combination of peptides which would thus be suitable tocombine to produce a cocktail of peptides. It was observed that thepeptides of SEQ. ID NOS: 1, 7 and 9 had complementary effects for thefollowing reasons.

The MHC binding motifs of each of SEQ. ID NOS: 1, 7 and 9 andimmunogenic fragments of the sequences are shown in Table 10.

TABLE 10 Peptide Sequence MHC Binding Motif SEQ ID NO. 1ALFSVLNYERARRPGLLGASVLGLDDIHRA Th (HLA-DR*01, 04, 07, 15)SVLNYERARRPGLLG Th (HLA-DR*01, 04, 07, 15) FSVLNYERARRPGLLTh (HLA-DR*01, 04, 07, 15) ARRPGLLGASVLGLD Th (HLA-DR*01, 04, 07, 15)BARRPGILLGASTLGL Th (HLA-DR*01, 04, 07, 15) VLNYEPARRPGLLGATh (HLA-DR*01, 04, 07, 15) RPGLLGASVLGLDDI Th (HLA-DR*01, 04, 07, 15)VLNYERARRPGLLGA Th (HLA-DR*01, 04, 07, 15) GLLGASVLGL CTL (HLA-A2, -B7)GLLGASVLG CTL (HLA-A2, -B7) LLGASVLGL CTL (HLA-A2, -B7) ALFSVLNYECTL (HLA-A2, -B7) RPGLLGASVL CTL (HLA-A2, -B7) RPGLLGASVCTL (HLA-A2, -B7) SEQ ID NO. 7 RTFVLRVRAQDPPPE Th (HLA-DR*01, 11, 15)RVRAQDPPPE CTL (HLA-A3) FVLRVRAQD CTL (HLA-A3) SEQ ID NO. 9AERLTSRVKALFSVL Th (HLA-DR*03, 11) RLTSRVKAL CTL (HLA-A2, -A3, -B44)RVKALFSVL CTL (HLA-A2, -A3, -B44) AERLTSRVK CTL (HLA-A2, -A3, -B44)ERLTSRVKAL CTL (HLA-A2, -A3, -B44)

As can be seen from Table 10 the peptides of SEQ. ID NOS: 1, 7 and 9 andtheir immunogenic fragments are able to bind to a wide range of HLAmolecules presenting either Th or CTL epitopes. Therefore, thesepeptides are able to generate immune responses over a very broad patientpopulation.

In addition, the peptides of SEQ. ID NOS: 1, 7 and 9 have provenimmunogenicity across the clinical responder patients reported inExample 6 and relatively greater immunological response in clinicalresponders than in clinical non-responders.

More specifically, for the peptide of SEQ. ID NO. 1 there wereimmunological responses in 7/7 clinical responders compared withimmunological responses in 1/10 clinical non-responders. Several of theresponding long term survivors also showed CTL responses by pentameranalysis.

For the peptide of SEQ ID NO 7 there were immunological responses in 5/7clinical responders compared with immunological responses in 1/10clinical non-responders.

For the peptide of SEQ ID NO: 9 there were immunological responses in3/7 clinical responders compared with immunological responses in 0/10clinical non-responders in addition to CTL responses shown by pentameranalysis in 3 of the patients, one of them being additional to the 3showing proliferative responses.

Accordingly, this analysis of the results demonstrates that a cocktailof peptides of SEQ. ID NOS: 1, 7 and 9 is expected to have a high levelof efficacy over a broad range of the human population.

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1. A method of treatment or prophylaxis of cancer in a patient comprising administering to the patient at least one selected from the group consisting of: a) a polypeptide comprising a sequence selected from the group consisting of: i) SEQ, ID NOS. 2, 3, 4, 7 or 8; ii) the sequence of an immunogenic fragment of i) comprising at least eight amino acids, wherein the immunogenic fragment is not one of SEQ. ID NOS. 6 or 11 to 16; or iii) a sequence having at least 80% sequence identity to i) or ii),  wherein the polypeptide is less than 100 amino acids in length and wherein the polypeptide does not comprise the sequence of SEQ. ID NO. 10 and does not consist of the sequence of SEQ ID NO. 56; b) a nucleic acid molecule consisting of a nucleotide sequence encoding the polypeptide of part a); and c) a pharmaceutical composition comprising the polypeptide of part a) or the nucleic acid molecule of part b) and a pharmaceutically acceptable adjuvant, diluent or excipient.
 2. The method according to claim 1, wherein the polypeptide comprises a sequence selected from the group consisting of: i) SEQ. ID NO. 1; ii) the sequence of an immunogenic fragment of i) comprising at least eight amino acids, wherein the immunogenic fragment is not one of SEQ. ID NOS. 6, 11 to 16 or 56; and iii) a sequence having at least 80% sequence identity to i) or ii), wherein the polypeptide is less than 100 amino acids in length.
 3. The method according to claim 2, part ii), wherein the sequence of the immunogenic fragment, or a sequence having at least 80% identity thereto, comprises at least 20 amino acids.
 4. The method according to claim 1, wherein the immunogenic fragment has the sequence of any one of SEQ. ID NOS. 17 to
 40. 5. The method according to claim 4, wherein the immunogenic fragment consists of the sequence of any one of SEQ ID NOS: 18, 24, 36 or
 37. 6. The method according to claim 1, wherein the polypeptide is less than or equal to 80, 50, 30, 20 or 11 amino acids in length.
 7. The method according to claim 1, wherein the cancer is selected from breast cancer, prostate cancer, pancreatic cancer, colorectal cancer, lung cancer, malignant melanoma, a leukemia, a lymphoma, ovarian cancer, cervical cancer, or biliary tract carcinomas.
 8. The method according to claim 1, part (a), wherein the polypeptide is linked to a substance selected from the group consisting of lipids, sugar and sugar chains, acetyl groups, at least one further polypeptide, natural polymers and synthetic polymers.
 9. The method according to claim 8, wherein the polypeptide is in the form of a lipopeptide conjugate.
 10. The method according to claim 1, part c), wherein the pharmaceutical composition comprises a further therapeutic ingredient.
 11. The method according to claim 1, part c), wherein the pharmaceutical composition comprises the polypeptide or the nucleic acid molecule in a dose of between 1 and 500 μg.
 12. A method of treatment or prophylaxis of cancer in a patient comprising administering to the patient at least one selected from the group consisting of: a) a polypeptide comprising the sequence of SEQ ID NO: 1, wherein the polypeptide is less than 100 amino acids in length and wherein the polypeptide does not comprise the sequence of SEQ ID NO: 10; b) a nucleic acid molecule consisting of a nucleotide sequence encoding the polypeptide of part a); and c) a pharmaceutical composition comprising the polypeptide of part a) or the nucleic acid molecule of part b) and a pharmaceutically acceptable adjuvant, diluent or excipient.
 13. The method according to claim 12, wherein the cancer is selected from breast cancer, prostate cancer, pancreatic cancer, colorectal cancer, lung cancer, malignant melanoma, a leukemia, a lymphoma, ovarian cancer, cervical cancer, or biliary tract carcinomas.
 14. The method according to claim 12, part c), wherein the pharmaceutical composition comprises a further therapeutic ingredient.
 15. The method according to claim 12, part c), wherein the pharmaceutical composition comprises the polypeptide or the nucleic acid molecule in a dose of between 1 and 500 μg.
 16. A method of treatment or prophylaxis of cancer in a patient comprising administering to the patient at least one selected from the group consisting of: a) a cocktail of polypeptides comprising at least two different polypeptides comprising sequences selected from the group consisting of: i) SEQ. ID NOS. 2 to 7; ii) the sequence of an immunogenic fragment of i) comprising at least eight amino acids; and iii) a sequence having at least 80% sequence identity to i) or ii),  wherein each polypeptide is less than 100 amino acids in length; b) a cocktail of nucleic acid molecules comprising at least two different nucleic acid molecules, each consisting of a nucleotide sequence encoding a polypeptide of part a); and c) a pharmaceutical composition comprising the cocktail of polypeptides of part a) or the cocktail of nucleic acid molecules of part b) and a pharmaceutically acceptable adjuvant, diluent or excipient.
 17. The method according to claim 16, wherein at least one polypeptide comprises a sequence selected from the group consisting of: i) SEQ. ID NOS. 1, 7, 8, 9 or 10; ii) the sequence of an immunogenic fragment of i) comprising at least eight amino acids; and iii) a sequence having at least 80% sequence identity to i) or ii), wherein the polypeptides are less than 100 amino acids in length.
 18. The method according to claim 16, wherein the at least two different polypeptides comprise a cocktail of polypeptides selected from the group consisting of: i) a cocktail of: a polypeptide comprising the sequence of SEQ. ID NO. 1 or a sequence having at least 80% sequence identity thereto or an immunogenic fragment thereof comprising at least eight amino acids; a polypeptide comprising the sequence of SEQ. ID NO. 7 or a sequence having at least 80% sequence identity thereto or an immunogenic fragment thereof comprising at least eight amino acids; and a polypeptide comprising the sequence of SEQ. ID NO. 9 or a sequence having at least 80% sequence identity thereto or an immunogenic fragment thereof comprising at least eight amino acids; ii) a cocktail of: a polypeptide comprising the sequence of SEQ. ID NO. 1 or a sequence having at least 80% sequence identity thereto or an immunogenic fragment thereof comprising at least eight amino acids; a polypeptide comprising the sequence of SEQ. ID NO. 8 or a sequence having at least 80% sequence identity thereto or an immunogenic fragment thereof comprising at least eight amino acids; and a polypeptide comprising the sequence of SEQ. ID NO. 9 or a sequence having at least 80% sequence identity thereto or an immunogenic fragment thereof comprising at least eight amino acids; and iii) a cocktail of: a polypeptide comprising the sequence of SEQ. ID NO. 1 or a sequence having at least 80% sequence identity thereto or an immunogenic fragment thereof comprising at least eight amino acids; a polypeptide comprising the sequence of SEQ. ID NO. 8 or a sequence having at least 80% sequence identity thereto or an immunogenic fragment thereof comprising at least eight amino acids; and a polypeptide comprising the sequence of SEQ. ID NO. 10 or a sequence having at least 80% sequence identity thereto or an immunogenic fragment thereof comprising at least eight amino acids, wherein each polypeptide is less than 100 amino acids in length.
 19. The method according to claim 16, wherein the or each immunogenic fragment has a sequence of any one of SEQ. ID NOS. 17 to
 40. 20. The method according to claim 16, wherein the cancer is selected from breast cancer, prostate cancer, pancreatic cancer, colorectal cancer, lung cancer, malignant melanoma, a leukemia, a lymphoma, ovarian cancer, cervical cancer, or biliary tract carcinomas.
 21. The method according to claim 16, part (a), wherein the at least two different polypeptides are each linked to a substance selected from the group consisting of lipids, sugar and sugar chains, acetyl groups, at least one further polypeptide, natural polymers and synthetic polymers.
 22. The method according to claim 21, wherein the at least two different polypeptides are each in the form of a lipopeptide conjugate.
 23. The method according to claim 16, part c), wherein the pharmaceutical composition comprises a further therapeutic ingredient.
 24. The method according to claim 16, part c), wherein the pharmaceutical composition comprises the cocktail of polypeptides or the cocktail of nucleic acid molecules in a dose of between 1 and 500 μg. 